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Observation vs. E/M codes

  1. Default Observation vs. E/M codes
    Medical Coding Books
    When the MD is seeing an established patient in the hospital setting (excluding a patient who came in via the ED), who is not an in-patient, and we are monitoring them for an issue. Is this an Obs charge or an E/M charge? When should Observation codes be used?

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    Quote Originally Posted by Nancy Russo View Post
    When the MD is seeing an established patient in the hospital setting (excluding a patient who came in via the ED), who is not an in-patient, and we are monitoring them for an issue. Is this an Obs charge or an E/M charge? When should Observation codes be used?
    If the doctor who is seeing the patient is the admitting doctor - the doctor who placed the patient into Observation, then he/she would be billing with the OBS charges. If the doctor who is seeing the patient is someone who was called in for a consult or is not the admitting doc, they would be billing with the regular outpatient codes - 99201-99205 or 99212-99215. Observation codes are used only by the admitting/attending physicans, so if your doc is there PCP, then use the office visit codes.
    Jodi Dibble, CPC

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